Tell Me What to Eat If I Have Diabetes

There was one specific diet to recommend for all persons with Type II diabetes. But there isn’t. The truth is
all persons with Type II diabetes are not created equal.

Each person needs to work out his or her particular eating, exercise, or medication plan that translates into normal blood sugars in their particular body. Some people seem to have better blood sugars with meals low in fat while others do better with meals richer in monounsaturated fat (30 to 40 percent calories from fat). But no matter which type of person you are, you will still need the tools to be able to count the fat and carbohydrates into your meal plan. We’ll give you those tools. There are other food patterns and nutrients that seem to help most people with diabetes. We’ll talk about that too. Most diabetes specialists believe there are three keys to managing diabetes:

  1. Monitoring your blood glucose levels.
  2. Exercising regularly.
  3. Following your personalized eating plan.

*diabetes care and management*

The Who, What, Where, Why, and How of Type 2 Diabetes

diabetes is reaching epidemic proportions. It is the third or seventh leading cause of death in the United States, depending on whether you include the people with diabetes who die from related cardiovascular disease.
Roughly 18 million Americans already have diabetes and many more will get it in the coming years as baby boomers age and the rise in adult and child obesity continues. Experts say that about eight to nine million Americans are walking around not knowing they even have diabetes.

Often they don’t find out until fairly severe damage has been done to their bodies. What
kind of damage? Diabetes is the leading cause of blindness, kidney failure, and leg amputations.
Once you have diabetes, your risk for heart disease can be four times greater. *diabetes care and management*

So telling you what to eat for Type II diabetes also has to include telling you what to eat to reduce your risk of heart disease. The types of food and meal choices that work best for diabetics (lower sugar, lower sodium, high fiber, fruits, and vegetables, with sources of monounsaturated fats and omega-3 fatty acids) are great for someone without diabetes.

The only difference is that someone with diabetes needs to carefully control and monitor their blood sugar and therefore sometimes needs to keep a count of carbohydrates, fiber, and fat grams throughout their day. *best snacks for low blood sugar*

The bottom line then for most people with Type II Diabetes, is eating good food at good times in good portions.

Who is at risk for Type II diabetes?

  • People age 45 and older.
  • People with a family history of diabetes.
  • People who are overweight.
  • People who do not exercise regularly.
  • Certain racial and ethnic groups (African Americans, Hispanic-Americans, Asian-Americans, Pacific Islanders, and American Indians).
  • Women who have had gestational diabetes or who have had a baby weighing 9 pounds or more at birth.

What exactly does insulin normally do in the body when the body isn’t resistant?

Insulin is a hormone normally produced as needed by the pancreas, and one of its major jobs is helping get glucose (energy) into various body cells. When blood glucose levels rise, the pancreas makes more insulin and releases it
into the bloodstream. The insulin then causes body cells to remove the excess glucose that is circulating in the blood.

In the liver and skeletal muscle cells, insulin encourages the production of glycogen (the storage form of glucose). In the liver and fat cells, insulin encourages fat production (stored energy).

At the same time, insulin discourages the breakdown of body fat for energy (lipolysis), causing the body to rely more heavily on the recently ingested carbohydrates for current energy needs. *one drop diabetes management*

What is Type 2 diabetes?

Type II diabetes is a metabolic disorder resulting from the body’s inability to make or properly use insulin. (Insulin is a hormone that converts sugar, starches, and other foods into energy.) It occurs when the body produces plenty
of insulin, but the insulin cannot do its job.

For some reason, the cells in the body have become resistant to insulin. In most cases,
being overweight or obese for a period of time could bring on insulin resistance. But there are people who are obese for many years who never develop diabetes. So scientists suspect that some people have a genetic predisposition (their particular family genes make them more likely to develop Type II diabetes under certain
conditions such as aging, weight gain, or an inactive lifestyle).

Ninety to 95 percent of people with diabetes have Type II. About five to 10 percent have Type I (usually diagnosed among children or in young adults, and usually not associated with obesity).

What are the warning signs of Type 2?

Often people with Type II don’t have obvious signs. But they could also have any of the following traditional Type I symptoms:

  • Frequent infections.
  • Blurred vision.
  • Cuts and bruises that are slow to heal.
  • Tingling/numbness in hands or feet.
  • Unusual thirst.
  • Frequent urination.
  • Extreme hunger.
  • Unusual weight loss.
  • Extreme fatigue.
  • Irritability.

Why do people get Type 2 diabetes?

Not all persons with Type II diabetes are created equal. It acts differently in every person. But most people with Type II diabetes start with the potential to develop the disease (genetic predisposition), based on family
history or ethnicity, that eventually becomes manifest through environmental factors such as aging, weight gain, or a sedentary lifestyle. *best snacks for low blood sugar*

What are the end-points of diabetes?

Diabetes is the leading cause of blindness in working-age adults in the United States, accounting for 24,000 new blind persons every year. The National Eye Institute estimates that 90 percent of lost vision is preventable.

  • Diabetes is the leading cause of end-stage renal disease in the United States. Approximately 28,000 patients with diabetes develop end-stage renal disease every year. With all the current therapies now available, future cases of end-stage renal disease are probably preventable.
  • Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States. *gestational diabetes 2 hours after meal*

How can I manage my diabetes?

Many diabetes specialists believe there are three keys to diabetes management success:

1 Monitoring blood glucose levels.

You need to monitor your blood glucose because that’s how you know right away if you are keeping your blood glucose near normal. And you need to keep your blood glucose near normal if you want to protect your body from developing diabetic complications further down the line. If your healthcare team knows how your blood sugar is being affected from day to day, they can help fine-tune your medications, your eating
plan, and your exercise routine.

Measuring your blood glucose will tell you rather quickly whether your treatments (diet, exercise, and pharmacological) are working for you. Make sure someone on your healthcare team clearly demonstrates how to measure your glucose and how to record it so it can be referred to easily at follow-up visits.

This is very important to the management of diabetes. Next to the discovery of insulin, the ability to monitor blood sugars was the biggest breakthrough in the treatment of diabetes.

2 Exercising regularly.

Exercise can actually help control blood glucose levels. Exercise depresses insulin production and also prompts skeletal muscle cells to take in more glucose from the bloodstream. With more glucose in your muscle cells, you can produce more energy so that your muscles can continue to work).

Besides helping to control blood glucose levels, exercise improves the cardiovascular system (thus reducing the risk of
heart disease) and also encourages weight loss, which can have big benefits for people with diabetes.

3 Following a personalized eating plan.

Follow a plan that helps keep your blood glucose levels normal, helps protect against heart disease and weight gain,
and doesn’t make you feel deprived.

Everything You Ever Wanted to Ask Your Dietitian…

Diet and Type 2 Diabetes

Do you have a list of foods I cannot eat? No—there isn’t a list of foods you absolutely cannot eat. All foods, with smaller serving sizes, can be worked into a particular eating plan. If dietitians tell you that you can’t have something anymore, it will only make you feel deprived and angry and you will only want to have that food more.

You ultimately decide what to eat. And it is you that will learn to associate certain foods in certain amounts and in certain combinations with higher blood sugars in your particular body. *best snacks for low blood sugar*

I have a sweet tooth, can I still eat some of my favorite desserts?

No one wants to be told they can’t have something— especially sugar. It only makes you want it more. And there is no
reason why people with diabetes can’t have sugar, as long as they keep a few things in mind. Bread and several other starches actually have almost the same effect on blood sugar in some people as refined sugar does.

The 1994 recommendations from the American Diabetes Association basically says if you are managing your blood sugar well, then you may have some sugar—but you’ve got to play by a few rules:

  • Pay attention to portion sizes of sugary foods. Keep servings moderate like 1/2 cup of ice cream or three Oreo cookies.
  • Try to enjoy your dessert or high-sugar treat as part of a meal. You will be less likely to overeat the treat if you have it with a meal and the dessert will be less likely to send your blood sugar soaring if it’s paired with other foods.
  • Substitute the sugar-containing food for another carbohydrate-containing food in your personal diabetes meal plan. Otherwise, you will not only increase the carbohydrates you’re taking in, you’ll also increase your calories.
  • Monitor your blood glucose routinely so you’ll be aware of any negative effects from the sugary food.

The lesson here: Go ahead and eat cake, but make it a modest slice and have it with your meal. One last bit of advice: Make sure these foods are truly satisfying, so you’ll be happy with the moderate amounts. *gestational diabetes 2 hours after meal*

How can I do this without counting and measuring foods?

I don’t like counting and measuring either. It automatically makes you feel “different” (and not in a good way) and frankly, it can take the fun out of eating. I would strongly suggest doing some counting of carbohydrate, fat, and fiber grams now and then just to sort of “check-in” with how you are eating.

When you compare it to blood sugars, this can be a great tool for you and your dietitian or diabetes educator. But if you really can’t bring yourself to do it, the only answer is to monitor, monitor, monitor (your blood sugar that is). Monitor your blood sugar three to six times a day, study your normal diet and the
resulting blood sugars, and soon you will know which foods/
meals work best.

The foods that do cause high blood sugar may just need to be eaten in smaller amounts each time, combined with other foods, or coordinated with a change in medication or exercise just when that specific food/meal is eaten.

Should I become vegetarian?

A vegetarian diet can be high in carbohydrates, making normal blood sugars harder to achieve for
some. If you choose to eat this way for other reasons, make sure you plan meals carefully to keep carbohydrates in check.

You will need to depend heavily on higher protein and fat plant foods such as nuts and soybeans or tofu and plant foods rich in soluble fiber to help buffer the carbohydrate-induced rise in blood glucose. What might appeal more to most people is to eat, not necessarily a “vegetarian diet,” but to just plain eat more
plant foods.

Why is it so important that I eat more plant foods?

“Plant foods” include fruits and vegetables, grains (such as bread, rice, pasta, and cereal,) tubers (includes the potato
family,) and legumes (includes the bean and pea family.) *gestational diabetes 2 hours after meal*

As you can tell from the list, these foods tend to be loaded with vitamins, minerals, fiber, and phytochemicals (plant chemicals that have health-promoting properties,) most of which help protect against cancer in a variety of ways. Nutrients in plant foods also help protect our bodies from other diseases such as heart
disease, stroke, and hypertension. Making plant foods take up a larger portion of our dinner plate can also help reduce obesity.

I’ve heard there is a type of fiber that is good for people with Type II diabetes. What is it?

Soluble fiber (the fiber that is soluble or dissolves in water) seems to be a vital component of blood glucose control for many people. It is found in peas and beans, oats and oat bran, barley, and some fruits and vegetables. Soluble fiber leaves the stomach slowly, so it makes you feel satisfied longer.

I notice it when I have beans with lunch, such as a bean burrito. (This is unusual because I am usually starving several hours after lunch.) Soluble fiber, which forms a gel within the intestinal tract, slows carbohydrate absorption and reduces the rise in blood glucose and insulin following the meal. Soluble fiber also has some disease-prevention benefits. *one drop diabetes management*

Are the popular very high protein, very low carbohydrate diets good for people with diabetes?

These diets aren’t good for anyone but they can be dangerous in people with Type II diabetes. People with diabetes are already at high risk for kidney disease (diabetes increases the rate that the kidneys age) and excessive food protein and
high blood pressure puts even more stress on the kidneys.

These are all just fad diets in disguise—they aren’t based on scientific and medical truths. Just think about it: Fruits, vegetables, and whole grains are some of the most nutritious foods on Earth, contributing vitamins, minerals, phytochemicals, and fiber. These foods are made up of mostly what? Carbohydrates.

And while it is true that insulin is normally released into the bloodstream when carbohydrates are eaten (in people without diabetes), the carbohydrates are stored as fat only if the amount of calories being eaten is greater than the amount needed by the body. So carbohydrates don’t automatically turn to fat unless you are eating too much.

Okay, so people say they have lost weight on these diets. The only thing that counts is whether they were able to
keep it off (and in this respect, people haven’t been as lucky.) People may lose weight on these diets but not because they are low in carbohydrates, but because they tend to be low in calories. People do lose weight quickly, but it isn’t fat they’re losing right away; it’s mostly body water. As you continue the diet, you will lose some fat pounds, but at the same time, you are losing muscle tissue. *gestational diabetes 2 hours after meal*

When you eat too few carbohydrates, your body automatically starts to sacrifice its protein tissue (from major organs and muscles) for energy. And when you gain the weight, back it is likely as body fat, not muscle tissue. Over time, losing weight and gaining it back a few times causes you to get fatter and fatter and lose more and more muscle tissue. The liver and kidneys also have to work harder processing protein into energy than carbohydrates. *best snacks for low blood sugar*

Are starchy foods such as pasta, potatoes, and bread, fattening?

All of these foods are high in carbohydrate calories. Carbohydrates are only fattening when we eat more calories than
our body needs. But this is also the case with foods high in protein and fat (especially fat). By including fruits and vegetables with these starches, we are more likely to keep our portions of these delicious starches reasonable.

For example, when you fix pasta, add in some broccoli or carrots. When you make a sandwich with bread, have it with an apple, a wedge of melon, or a small bowl of fruit salad. With bread, you also have the opportunity to increase your daily fiber total by choosing bread that either contains whole grains or contains added soluble fiber. *diabetes care and management*

I’m confused. Is fat in food good or bad? I know it’s bad with some diseases but I also know it helps me control my blood sugars?

Let me tell you a story. Once upon a time, all that the townspeople knew about food fatwas that it tasted good and kept their bodies a little padded so they could better survive the winter and periods when food was scarce. People often cooked their food in lard or shortening. They uninhibitedly spread butter on their bread, corn, and potatoes. People delighted in drinking extra-rich milk. Fatty meats and sausages were considered highly desirable. What bliss!

Over the past 15 years, needless to say, things have become much more complicated. Fat in food is feared; its mere presence has been known to inflict massive guilt on people. But the latest studies are showing us that some fats have a protective effect on our bodies in terms of heart disease and some cancers. *one drop diabetes management*

They are also showing that there may not be one “right” amount of fat for all people—some people may fare better with more or less fat than others. Researchers are probably going to battle this out in the years to come but in the meantime, you’re trying to get a better handle on your blood sugars, your weight, and your risk of heart disease.

I don’t blame you for being confused. Most of us health professionals are trying to figure it all out too. Yes, having a
moderate-fat diet (30 to 35 percent calories from fat) seems to add up to better blood sugars for some people with Type 2 diabetes compared to a very low-fat diet (10 to 20 percent
calories from fat). The fat helps slow down digestion in general, and “paces” the introduction of glucose (from carbohydrates eaten) into the bloodstream. For a variety of reasons, fat also helps some people feel more satisfied after a meal or snack.

The tricky part is knowing how much is enough for the diabetic benefits but not too much that it increases your risk
of other chronic diseases as well as weight gain. I would try to stick around 30 to 35 percent calories from fat and see what effect it has on your blood sugars, weight, and blood lipid levels. This way you could still have about 15 to 20 percent calories from protein, leaving around 45 to 55 percent calories from carbohydrates (hopefully mostly from whole grains, beans, fruits, and vegetables.)

As part of this moderate-fat eating plan, you absolutely must turn to the more heart-protective fats to make up most of this “35 percent”—the omega-3 and omega-9 fatty acids and the monounsaturated fats. This means using canola oil and olive oil in cooking, choosing products that contain liquid canola oil or olive oil (non-hydrogenated), including flaxseed, enjoying a handful of nuts now and then, and eating fish a couple
times a week. *diabetes care and management*

If you like eating out, these new rules could cramp your style. Most fast food and restaurants do not use liquid canola
and olive oil (except maybe an Italian or Mediterranean restaurant.)

What about the advertisements I hear for foods and products that help you burn body fat fast, even while you sleep!

To burn more body fat, your body has to require more calories than it is taking in with food. This means exercise, building muscle, and eating a little less than your body requires. You know what they say—if it sounds too good to be true, it usually is.

Anybody can tell you anything to help sell a product. For most quick and fast claims, there is no real science backing them up. You should also avoid buying weight-loss products using “speed” substances such as ephedra, ma huang, guarana, or high doses of caffeine. These may artificially increase your metabolic rate but can be dangerous.

These substances do not offer any long-term weight-loss advantages and that’s
what matters. Try to avoid the temptation of a quick fix. Trimming off extra pounds takes time. Concentrate on eating healthy and exercising, because they benefit your body in many
different ways—trimming extra weight is just one of them. *one drop diabetes management*

What are bad and good cholesterol?

A high level of LDL-cholesterol in the blood increases the risk of fatty deposits forming in the arteries, increasing the risk of a heart attack. That’s how LDL has gotten its nickname as the “bad” cholesterol. Elevated levels of HDL cholesterol, on the other hand, seem to have a protective effect against heart disease, which is why it has been coined “good” cholesterol. What about “total” serum (blood) cholesterol levels?

Many people think lowering food cholesterol is the most important step toward lowering blood cholesterol. Eating less saturated fat has a stronger effect on lowering blood cholesterol levels. Some studies, though, have found that eating cholesterol increases the risk of heart disease, even if it doesn’t increase blood cholesterol levels. *gestational diabetes fasting numbers*

Foods and blood sugars

How and why do certain foods raise blood sugars more than others do? I find that pizza, for example, causes higher blood sugars than candy?

The foods we eat contain different amounts and combinations of carbohydrates, protein, and/or fat. Vegetable oils contain all fat and granulated sugar contains all carbohydrates Other foods contain two or three of these. All of the grams of the digestible carbohydrates we eat convert to glucose, while about half of the protein and 10 percent of the fat grams we eat convert to glucose after digestion.

Carbohydrates, protein, and fat show their peak effect on blood glucose Carbohydrates, protein, and fat show their peak effect on blood glucose at different times after a meal, too: close at different times after a meal, too:

• Simple sugars—Peak 15 to 30 minutes after the meal.
• Complex carbohydrates—Peak 1 to 1 1/2 hours
after the meal.
• Protein—Peaks 3 to 4 hours after the meal.
• Fat—Peaks 3 hours after the meal.

*newborn blood sugar*

How a particular food affects your blood glucose has to do in part with the combination of carbohydrates, protein, and
fat in the food and the portion size you eat. How quickly the food is absorbed (and how quickly it affects blood glucose
levels) also has to do with things, such as the physical form of the food, whether the food is cooked, and what blood glucose levels were before the meal. One trick all people with diabetes have up their sleeves is dietary fiber. Dietary fiber, which is not digested by the body, causes other carbohydrates in the meal to be digested and absorbed more slowly.

However, people respond differently to carbohydrates. The same meal eaten by different people might have varying effects on blood glucose levels. And in some people, insulin becomes less effective after they eat high animal fat meals. This can also bring on high blood sugars. The only way to know for sure how your blood sugar responds to a particular meal is to test your blood sugar before and two hours after the meal. *gestational diabetes fasting numbers*

What are the meals/foods that surprisingly encourage higher blood sugars than expected in some people?

Some health professionals call this, “the pizza effect.” So you can guess what is at the top of this list—pizza. Other foods that cause many people problems are:

• Chinese food in general (Chow mein in particular).
• Ramen noodles.
• Bagels eaten plain (even one bagel can cause a problem for some). Start with half a bagel and eat it with some peanut butter or light cream cheese.
• Fried foods (such as fried chicken and french fries).
• Granola cereal (start with 1/4 cup).
• Pasta (try a 1-cup serving of cooked 100- percent durum wheat semolina pasta, and start the meal with a soup or salad).
• High animal protein/fat meals (including those with lots of cheese).

Are there any foods that, when part of a meal/ snack that usually invites high blood sugars, seem to help prevent the higher blood sugars after the meal?

Adding plant foods that contribute some fat and/or protein to the meal (nuts, soyfoods, olive and canola oil, flaxseed, avocado) seems to help minimize high blood sugars from notorious high carb meals. But if you have a meal high in animal fat that usually brings on high blood sugars (pizza, high-fat breakfasts, etc.), loading up on fiber (soluble fiber in particular) about 10 minutes before you start the meal may help. Higher soluble fiber plant foods will also help minimize high blood sugars from high carb meals too. As an appetizer (a little before you eat the entrée) try:

*newborn blood sugar*

• A green salad with kidney beans and raw vegetables.
• A cup of vegetable or bean soup.
• A small serving of oat bran or oatmeal (before a problematic breakfast).
• Other high soluble fiber vegetables (see Chapter 4 for a list).

• Other high soluble fiber grain foods (see Chapter 4 for a list).
• Psyllium seed foods and supplements (powders without intestinal stimulants are available, psyllium is also added to a couple of breakfast cereals). *gestational diabetes fasting numbers*

How come I seem to have higher blood sugars after high-fat meals instead of high-carbohydrate meals?

Some people seem to have high blood sugars after meals particularly high in animal fats such as bacon and eggs or pizza topped with sausage and pepperoni. Some researchers think that in some people (particularly certain ethnicities) insulin becomes less effective after meals laden in animal fat. If you notice this happens with you, try having smaller portions of the fatty foods and add in some plant foods (fruits, vegetables, and grains, especially those rich in soluble fiber) and see if it makes a difference. Instead of bacon and eggs and hashbrowns, try one sausage link, one egg, and pancakes or a bowl of oatmeal. Trade-in your four slices of “animal lover’s pizza” for:

• A couple of slices of “vegetable lover’s” pizza. Plus…
• A green salad with kidney beans and an olive oil vinaigrette or a nice cup of vegetable or bean soup to go with it.

What is the percentage of carbohydrates, fat, and protein that seems to help most people with Type II diabetes control blood sugars?

According to Certified Diabetes Educators who I spoke with, about 1/3 of the people with Type II diabetes tend to do better with an eating plan including around 35 to 40 percent calories from fat (using mostly monounsaturated fats) while 2/3 tend to fair best with a 25 to 30 percent calories from fat. But there are many other food factors, other than the percent of fat or carbohydrates, that can influence blood sugar control such as total fiber/soluble fiber, and
whether proteins and fats come mostly from vegetable sources. *gestational diabetes fasting numbers*

Who tends to do better with higher carbohydrate, lower fat meals?

People whose insulin seems to be less effective after high saturated/animal fat meals (which seems to include Asians,
Pacific Islanders, and African Americans), tend to do better on a higher carbohydrate eating plan (especially if they are not exercising regularly). Including foods rich in soluble fiber helps many people tolerate a higher carbohydrate meal. *newborn blood sugar*

What is a good breakfast if your blood sugars tend to be high in the morning?

Many people with Type II diabetes have trouble with morning blood sugars, not necessarily because of what they
ate for breakfast but because their “wake-up” blood sugars started high. Many people tend to be more resistant to insulin in the morning. Start by fixing yourself a nice balanced breakfast, with carbohydrates, protein, and fat. You can do this by adding nuts to cereal and muffins. Some people don’t mind adding soy milk or almond milk to their cereals in the morning. If you are having pancakes, serve up a couple of slices of turkey bacon. If you are having a bagel, add a slice of ham and cheese, a tablespoon or two of peanut butter, or 1/8 cup of light cream cheese.

What about wine? Does one glass at dinner help lower blood sugars?

A glass of red wine with dinner does seem to encourage lower blood sugars for some people, but it is very individual. For others, the opposite can happen—blood sugars seem to rise later that night. Sweeter wines tend to bring on
higher blood sugars. So people tend to do better with red wines and drier wines. If you do have a glass of wine with dinner, check your blood sugar before bed, and if you can try testing
your blood sugar at 2 or 3 a.m. every now and then.


You’ve heard the expression “you can lead a horse to water but you can’t make him drink.” I have been
dragging my Type II father (whom I love with all my heart) to the water for 15 years, and…well, he’s not drinking. Oh sure, every now and then he might sip the water a little, or dip his toe in it, but he’s not drinking. He just hasn’t
been interested in controlling his blood sugars. He won’t write down what he is eating and the resultant blood sugars
so that we can figure out patterns.

For 15 years I have watched him slowly lose his ability to drive, walk, travel. We are at the point where every month he
is in the hospital for congestive heart or leg infections. Even now he isn’t interested in controlling his blood sugars. All I
can do now is just love him, keep him company when my mom is working a long day, scratch his back (one of his favorite things), and just generally savor every precious moment my children and I get to spend with him.

I applaud you for being motivated enough to improve your health and diabetes that you finished this book. I can’t say I
know exactly what you’re going through, because I don’t personally have Type II diabetes…yet. But I do understand. And if this book has somehow made your life with diabetes more enjoyable and more comfortable, then all the long hours of writing and research were well worth it. *newborn blood sugar*

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